Scottsdale Fire, HonorHealth launch mobile health program

The Scottsdale Fire Department and HonorHealth hospital network have teamed up to launch the city’s first mobile integrated health-care program that will specialize in home visits with the area’s most vulnerable medical populations.

Following other Valley cities such as Mesa and Chandler, the partnership will bring individualized medical advice and attention to patients’ doorsteps without the time or expense of costly 911 calls and emergency-room visits, the program’s organizers said.

The programs come as part of a national trend in shifting health care from the hospital to the home. Mobile units, such as the team in Scottsdale, usually consist of a nurse practitioner and a paramedic. The teams provide general health screenings, check patients’ homes for potential fall or trip hazards and help them connect to resources to manage chronic medical conditions, said Dr. Franco Castro-Marin, the Fire Department’s Medical Director and an emergency-room physician with HonorHealth.

“We’re all so excited about this,” he said, adding that health-care strategists have predicted the rise of mobile services since the mid 1990s. “Finally in 2015 this is happening.”

While the Fire Department and hospital network had been batting around ideas for a mobile team for several years, the merger of Scottsdale Healthcare and John C. Lincoln Health Network in October of 2013 stalled the process until a few months ago. Since then, a small team has researched and shadowed other programs and training for their new roles.

Nurse Practitioner Ashley Bevier of HonorHealth and Captain Paramedic Steve Richter of Scottsdale Fire will work full time to do visits together during the program’s trial year. HonorHealth will fund the program temporarily and will reimburse the Fire Department for Richter’s salary. The service will be free for the first six months, after which hospital will work with insurers and decide whether it will need to charge for the program, Castro-Marin said.

Scottsdale and HonorHealth looked at records of 911 calls and data from emergency-room admissions to identify between 200 and 300 candidates who use the services frequently. The program’s end goal is to keep patients healthy before emergencies happen, which will improve the quality of service, their quality of life and the bottom line cost of the care.

“The traditional thinking is that EMS is a 911 call, but that model is not particularly patient focused and it can get expensive,” Castro-Marin said. A typical ambulance ride can cost upwards of $1,000, a heavy burden for patients and insurers to bear, especially when national data from the early 2000s showed that up to 35 percent of emergency-room patients could have forgone the trip if they had access to better resources at home.

True health and wellness programs need to factor in more than just a patient’s age and genetics, the team said. Social factors such as education levels and whether a patient is living below the poverty line have a significant impact on the ability to get to a doctor’s office for appointments, pick up medication on time and understand exactly how it follow up with care.

Often the solution to a better life is as simple as helping someone find the right phone number to call to ask questions or identifying a public-transit line to a clinic, Bevier said. “We’re there for them however they need us as long as they need us,” she said. “Even if it’s something like opening up the fridge and talking about what foods are good to eat if you have diabetes.”

As a nurse practitioner, Bevier will be able to perform full medical checkups as well as prescribe medications, although the focus of the program is to better connect patients to existing doctors and resources, not replace their regular physician. She plans to help patients go through any medications they are taking. If patients have questions, they can call the pharmacy or prescribing doctor together to ask.

Whether it takes two weeks or 12 months, Bevier and the other organizers want all patients to feel better physically and in control of their own care. Not only will that mean taking the time to work with them one on one, but also giving patients an equal say in decision making. “They have to be willing to help themselves for this to work,” she said.

Both Bevier and Castro-Marin said the program is exciting because its individual and interactive nature is so different from the way most doctors and nurses are trained. To help prepare them for their new roles and standardize the program’s training process, all three team members are taking an online accreditation course designed through Castro-Marin’s private employer, EmCare, a third company that helps place doctors in ERs and connected him with HonorHealth.

Richter more than the others will do a complete about-face in his role on the team. “My job on the truck is to take care of the patient and get them to the hospital fast,” he said. “Now I keep them from going to the hospital. It’s less in the moment and more 360 degrees and longitudinal.

“A lot of times out in the field you’re working with patients who don’t know their medical history or they’re taking medication but don’t know why,” Richter said.

He remembered a particular case where a man kept falling when he got out of bed and called 911 each time. It turns out that he was getting up too fast and his blood pressure would drop, causing him to collapse. The solutions aren’t always that simple, but it will feel good to be able to help prevent problems instead of just respond, he said.

The team plans to start home visits by mid August. Potential patients can call a 10-digit phone number available through the city to connect with the service.

Article source: http://www.azcentral.com/story/news/local/scottsdale/2015/08/07/scottsdale-fire-honorhealth-launch-mobile-health-program/31280195/